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Emergency personnel worldwide witness the effects of violence
in society while caring for its victims. Over the last decade, ED
personnel have also witnessed an increased prevalence of violence
within the ED. Multiple factors contribute to verbal and physical
assaults on ED staff members: unlimited and unrestricted access
to patient care areas, family and friends of critically ill patients
who have heightened levels of frustration and anxiety, patients
who are substance abusers, prolonged waiting times, staff shortages,
overcrowding, patient financial problems, and high expectations
of the patients. ED personnel have very close interaction with the
public and handle drugs, both of which are workplace characteristics
that make violence more likely.1 As a 24/7
operation, the ED is also exposed to the increased violence that
occurs at night.2 As the problem of violence in
the ED has increased, so has the body of literature that addresses
this issue (see PubMed search hits for violence and emergency department
by decade in Table 293.1-1).

Workplace violence at educational institutions and government
facilities captures the headlines, but more than any other profession,
physicians and nurses are victims of nonfatal violent crime.3 More
than 96% of ED physicians, nurses, and paramedics indicate
that they have witnessed violence within the ED in the prior 6 months.4 Violent
acts occur during 5% of EMS calls, and 69 health care workers
were killed between 1996 and 2000.5–7

ED personnel are victims as well as witnesses of violence in
the ED. One hundred percent of nurses working in a Florida hospital
noted that they were victims of verbal abuse while at work, while
81% were victims of physical abuse while at work over the
past year.8 Almost 12% of ED attending
physicians in a single survey had been confronted by an agitated or
violent patient outside of the ED, with an additional 3.5% citing
a stalking episode within the past year.9 Sixty-two
percent of residents and new graduates surveyed worry about their
safety while working in the ED.10 In the last data
published, which are now 2 decades old, only 62% of departments
had a 24-hour security presence on the premises.11

Violent events and confrontations have consequences for both
the patient and staff members. Immediate consequences include delayed
care for other ED patients due to the time and labor-intensive nature
of dealing with a violent individual in the department. Delayed
consequences include physical and psychological trauma suffered
by staff, resulting in decreased productivity, lost work time, lowered
morale, and, finally, burnout. Reports indicate that 48% to
83% of workers experience reduced personal morale and ...